TRAUMA-INFORMED PRACTICE: ASSESSING & TREATING CHILDREN FOLLOWING A DISASTER

1. TRAUMA-INFORMED PRACTICE: ASSESSING & TREATING CHILDREN FOLLOWING A DISASTER Karen Rice, PhD, LSW, ACSWMarc Felizzi, PhD, LCSW Assistant ProfessorsDepartment of Social WorkMillersville University

2. TRAUMA • A Psychophysical reaction to an event which is experienced as overwhelming • An event that arouses a strong emotional reaction in those exposed to it (Rothschild, 2000)

3. Symptoms of trauma • Hyper-arousal: state of alertness, expecting the danger to recur, feels as if danger is still present • Intrusion: Trauma interrupts daily life (e.g. flashbacks, re-enacting the traumatic event) • Emotional constriction: Feeling numb, dissociating, feeling a disconnect between events and their meanings. Feelings of “unreality” • Avoidance behavior: A means of preventing a confrontation with danger • (Briere & Scott, 2006)

4. TRAUMA TYPES • According to the National Child Traumatic Stress Network (NCTSN) there are 12 types of trauma children might experience • Community and school violence • Complex trauma • Domestic violence • Early childhood trauma • Medical trauma • Natural disasters • Neglect • Physical abuse • Refugee and war zone trauma • Sexual abuse • Terrorism • Traumatic grief

5. Trauma and the brain • The brain responds to external influences • Brain controls the nervous system & is linked to other parts of body • During a traumatic event or flashback, amygdala becomes activated, and hippocampus shuts down, which interferes with the ability to “make sense” of event (Rothschild, 2000)

6. Trauma and the brain • Systems of the brain process experiences by receiving & responding to perception of stress (flight/ fight/ freeze) -Amygdala: stores emotions & reactions to traumatic events; present at birth (implicit memory; experienced in body or senses) -Hippocampus: processes data as a narrative, makes sense out of experiences, matures about age 3 (Explicit memory; linguistic) (Rothschild, 2000)

7. Trauma and the brain • Limbic system produces cortisol, which is used to return body to equilibrium after stress/ trauma • Increased cortisol levels seen in trauma victims (Rothschild, 2000)

8. TRAUMA AND CHILDREN • Developmental Trauma • Attachment • Biology • Mood regulation • Dissociation • Behavioral control • Cognition • Self-concept (Child Welfare Committee, 2008; NCTSN; van der Kolk, 1996)

9. Children’s cognitive reactions • Confusion, disorientation • Fear of separation from family/ pets • Recurring dreams or nightmares • Preoccupation with disaster • Trouble concentrating or remembering things (schoolwork) • Difficulty making decisions • Questioning spiritual beliefs (Rothschild, 2000)

10. Children’s behavioral reactions to trauma • Sleep problems • Crying easily • Avoiding reminders of disaster • Excessive activity level • Increased conflicts with family • Hyper-vigilance, startle reactions • Isolation or social withdrawal • Focus on disaster/ worry another will occur • Lack of interest in usual activities, even playing with friends • Returning to earlier behaviors, such as baby talk, bedwetting, or tantrums • Increase in teens' risky behaviors, such as drinking alcohol, using substances, harming themselves, or engaging in dangerous activities (Rothschild, 2000)

11. Children’s physical reactions to trauma • Fatigue, exhaustion • Gastrointestinal distress • Appetite change • Tightening in throat, chest, or stomach • Worsening of existing medical conditions • Somatic complaints (Rothschild, 2000)

12. approaches to treatment of traumatized children • Counseling • Psychodynamic-Trauma-Focused Therapy • Cognitive Behavioral Trauma-Focused Therapy (CB-TFT) • Trauma Focused Therapy • Psychotropic Medication • Exposure Therapy • Relaxation Therapy • Creative Arts Therapy

13. Goal when working with children who experienced trauma • Establish sense of safety • Regulate affect • Reestablish attachment • Enhance brain’s executive function • Reframe and integrate traumatic experience (Malchiodi, 2008)

14. Establish sense of safety • Where do you feel safe? • Sense of safety essential to resolving trauma experience • Ask questions to assess: • “Where do you fee the safest?” • “Who do you feel the safest with?” • “What do you do to feel safe?” (Malchiodi, 2008)

15. Regulate affect • Important to address body’s response to trauma • Trauma prevents normal expression of cognitive processes • Goal is to empower individuals to regulate reactions to stressful events • Questions to ask: • “How big or small is your hurt?” • “If your hurt could talk, what do you think it would say?” • “If your hurt could listen, what would you say to it?” (Malchiodi, 2008)

16. Reestablish attachment • Identifying institutions to foster supportive relationships is essential • Foster and build supportive networks • Strengthen friendships and peer support (Malchiodi, 2008)

17. Enhance brain’s functioning • Provide youth with opportunity to discuss disaster-related events • Promote positive coping and problem-solving skills • Emphasize strengthening resiliency to • Take decisive actions; do not avoid • Avoid blowing event out of proportion (Malchiodi, 2008)

18. Reframe and integrate traumatic experience • Telling one’s story gives trauma survivors a voice • Stories link past, present, and future • Reparative nature to “restory” one’s life (Malchiodi, 2008)

19. Issues associated with specific disaster: fires • Emotional and physical exhaustion • Survivor guilt • Fear and anxiety • Lingering distress (Malchiodi, Steele, & Kuban, 2008)

20. Focus of treatment-specific to fires • Provide perceptions of safety and security • Provide opportunity to discuss feelings and concerns to correct misperceptions and to offer reassurance • Provide predictable activities and normal routines • Provide and maintain interpersonal connections • Encourage healthy behaviors • Educate and encourage parents/caregivers to model positive coping skills • Reduce exposure to events that increase stress • Encourage participation in less stressful events • Develop response plan that addresses psychological impact (Malchiodi, Steele, & Kuban, 2008)

21. Questions “Trauma stays with us even though the trigger may appear to be out of sight” (Rothschild, 2000)